Appendix C: Sample glucose monitoring record sheet
| Name:_________________________ |
| Target Blood Sugar Levels | Remember, if your blood sugar is out-of-range: |
Fasting
1 hour after eating
2 hours after eating
| No higher than 95
No higher than 140
No higher than 120
| Write down what you ate and how much you ate in the Notes column. Write down what exercises you did and how long you did it in the Notes column. Write down any skipped meals or snacks in the Notes column. |
| Date | Blood Glucose Level | Insulin
Amount | Urinary
Ketone
Levels | Notes |
| Fasting | 1-2 Hours
after Breakfast | 1-2 Hours
after Lunch | 1-2 Hours
after Dinner |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
